Provider Demographics
NPI:1740225671
Name:MESKUNAS-VANPELT, JILL A (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:MESKUNAS-VANPELT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:MESKUNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4513 OLD VESTAL RD
Mailing Address - Street 2:STE 3
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229-231 STATE ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2756
Practice Address - Country:US
Practice Address - Phone:607-778-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0699781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07300069978Medicaid
NYRA2363Medicare ID - Type Unspecified